REM sleep behavior disorder and vocal cord paralysis in Machado-Joseph disease.

We evaluated the occurrence of REM sleep behaviour disorder (RBD) and vocal cord abductor paralysis (VCAP) in a group of 9 Machado-Joseph disease (MJD) patients. RBD was diagnosed by clinical history plus audiovisual polysomnography in 4 men and 1 woman (55%). While dreaming, 4 fell out of the bed and the other injured his arms. Laryngoscopy detected bilateral VCAP in 1 patient with stridor who required emergency tracheotomy, and partial vocal cord abductor restriction in 2. RBD and VCAP are two potentially injurious conditions that should be considered part of the clinical spectrum of MJD.     

阻塞性睡眠呼吸暂停综合征患者手术治疗的麻醉研究

目的：探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome，OSAS)患者手术治疗的麻醉处理。方法：72例OSAS患者手术前先正压通气治疗(continue positive airway pressure，CPAP)和评价上气道，55例患者经鼻或经口气管插管全身麻醉；在手术完毕患者完全清醒后拔除插管。结果：72例患者中，轻度16例、中度24例、重度32例。合并晨起高血压28例，心电图均有不同程度心肌缺血的表现；红细胞增多症12例；腭咽平面Ⅰ级9例、Ⅱ级24例、Ⅲ级的27例、Ⅳ级12例。术前3．5d行自动调压正压通气治疗(Auto—CPAP)，经口气管内插管48例，经鼻气管内插管6例，均无术中插管困难和术后高血压危象，呼吸道梗阻发生。结论：充分认识OSAHS患者全身麻醉的手术风险，术前CPAP治疗和上气道评估，术中正确处理、严格掌握气管内插管、术后拔管的时机，是保证OSAHS患者手术成功、麻醉安全的关键。     

Lithium increases slow wave sleep: possible mediation by brain 5-HT2 receptors?

The effect of lithium on slow wave sleep (SWS) was studied in ten normal male volunteers using home based cassette sleep recording and automatic sleep stage analysis. Lithium increased SWS, an effect consisten with a reduction in brain 5-HT₂ receptor function.     

阻塞性睡眠呼吸暂停患者临床表现与上气道阻塞部位关系的探讨

目的 观察一组AHI接近的阻塞性睡眠呼吸暂停综合征（OSAS）患者中上气道阻塞部位对多导睡眠监测（PSG）图及临床表现的影响。方法选取36例AHI为30—40的成年男性OSAS患者行再次整夜PSG，加同步上气道及食道压力监测确定上气道最低阻塞部位。比较上气道最低阻塞部位在软腭水平、舌根水平和下咽水平的不同患者中PSG相关参数：平均SaO2、最低SaO2、最长阻塞性呼吸暂停事件时间、呼吸暂停事件中SaO2下降率（dSaO2／dt）、微觉醒指数；以及部分临床表现参数：白日嗜睡程度、入睡前收缩压／清晨收缩压、入睡前舒张压／清晨舒张压以及高血压发生率。结果平均SaO2、最长阻塞性呼吸暂停事件时间和入睡前收缩压／清晨收缩压比值在3种不同上气道最低阻塞部位患者中差异无显著性（P〉0．05），但与软腭水平相比，舌根水平和下咽水平的最低Sa02降低（P〉0．05），dSaO2／dt（％／s）比值增高（P〈0．05），微觉醒指数及白日嗜睡评分增高（P〈0．01），入睡前舒张压／清晨舒张压比值降低（P〈0．05），最低SaO2〈80％的发生率增高（P〈0．01）以及高血压的发生率增高（P〈0．01）。结论AHI接近的OSAS患者上气道阻塞部位在舌根水平以下者与软腭以上水平者相比，阻塞性呼吸暂停事件的致缺氧效率和程度提高，OSAS的临床表现加重。     

Pressure stability of nasal CPAP and bilevel devices

Summary Question of the study   Nasal continuous positive airway pressure (CPAP) prevents collapse of the upper airway during sleep in patients with obstructive sleep apnea provided that a positive transmural pressure can be maintained during inspiration. We examined pressure-flow characteristics in seven CPAP and bilevel devices during spontaneous breathing.
Methods   The CPAP devices were set to a pressure level of 9.8  hPa (10  cm H₂O) and adapted to a pneumotachograph using a standard CPAP hose and an outlet valve. We continuously measured flow, volume and pressure during resting ventilation and increasing voluntary hyperventilation and analysed the dependence of the variables on a breath-to-breath basis.
Results   Mean CPAP pressures differed between the devices (9.9 – 10.6  hPa) despite the same settings. In all machines pressure fell during inspiration to 8.4 – 9.8  hPa and increased during expiration to 11.1 – 11.7  hPa. This effect increased with higher flow rates. Maximum expiratory pressures rose to 12 – 19  hPa at peak flow rates of 2 l/s, mean expiratory pressures to 9.5 – 16  hPa. Inspiratory pressures dropped to 8.5 – 4.5  hPa (minimum) and 10.5 – 6.0 (mean). Bilevel devices showed a higher stability than CPAP devices. Pressure swings during the respiratory cycle increased the additional work of breathing.
Conclusions   Due to differences in mean and effective CPAP levels CPAP devices are not simply exchangeable but should be individually adapted. Patients with higher minute ventilation might benefit from more stable CPAP machines. The impact on patients' compliance remains to be evaluated.     

A study of the interrupted REM episode

Brief interruptions of REM sleep are considered to be part of the REM episode. The maximum allowable duration of such an interruption, which is used to define the end of the REM episode, is currently a matter of debate. Making measurements on individual REM cycles, inter-REM interval analysis was carried out to determine whether the generally adopted 15 minute empirical rule for this maximum needs to be extended to 25 minutes as suggested by several including Kobayashi et al. Our results show that there is no reason to alter the 15 minute rule and that measurements which do not take into account the time-of-night effect may be misleading. The proportion of interrupted REM episodes observed in our population of healthy adults is high. We have therefore also examined in some detail the phenomenology of the temporal evolution of the structure and content of the interrupted REM episodes. Both showed a definite change over the night: the interruptions in the earlier episodes tend to return the system to slow wave sleep while those in the later episodes tend to return it to wake. It is hypothesized that these interruptions reflect a measure of REM sleep pressure and its interaction with both slow wave sleep and wake pressures.     

悬雍垂保留在悬雍垂腭咽成形术中的作用

目的 探讨悬雍垂保留在悬雍垂腭咽成形术(UPPP)中的作用。方法 比较43例UPPP与43例保留悬雍垂的改良UPPP的术中术后并发症、术后症状改善程度以及术后咽腔测量结果。结果 术中术后大出血、开放性鼻音、进流食返呛人鼻腔等并发症：改良UPPP明显低于UPPP(P＜0．05)；咽异物感：改良UPPP极明显低于UPPP(P＜0．01)。术后1年患者主观症状改善程度：明显改善者，改良UPPP高于UPPP，无改善者，UPPP高于改良UPPP，有显著性差异(P＜0.05)。术后1年咽腔扩大程度：下腭咽横径、前后径，改良UPPP较UPPP两者均明显扩大(P＜0.05)。结论 UPPP中保留悬雍垂可明显降低术中术后大出血、开放性鼻音、进流食返呛人鼻腔、咽异物感等并发症，术后症状明显改善，咽腔得到明显扩大。     

Sleep complaints and their relation with drug treatment in patients suffering from Parkinson's disease.

The aim of this research was to quantify sleep problems in patients suffering from Parkinson's disease by means of the new Parkinson's Disease Sleep Scale (PDSS) and to correlate such problems with the possible influence of current drug treatment. A total of 70 patients (36 men and 34 women) with a diagnosis of Parkinson's disease were enrolled. Their mean age was 69.7 +/- 8.2 years, and duration of disease was 7.4 +/- 4.8 years. All patients completed the PDSS and the Unified Parkinson's Disease Rating Scale (UPDRS Parts I-IV). Drug consumption and doses were registered. The mean score on the PDSS scale was 109.23 +/- 19.75 and on the UPDRS III scale was 25.24 +/- 11.35. The lowest scores were obtained in Item 3 (sleep fragmentation): 5.53 (2.46); and in Item 8 (nocturia): 5.75 (2.91). There was a weak correlation between the PDSS and UPDRS III (cc = -0.355, P = 0.003), PDSS and UPDRS I (cc = -0.272, P = 0.02), and PDSS and UPDRS IV (cc = -0.416, P < 0.001). Motor conditions, mental state, and drug complications influence sleep quality. Although this effect was significant, it was not of a great magnitude. Dopaminergic drugs did not increase daytime sleepiness. As a whole, sleep quality in patients who took dopaminergic agonists did not differ from that of patients who took levodopa in monotherapy.     

高血压合并阻塞性睡眠呼吸暂停的短期血压变异性研究

目的 比较高血压合并阻塞性睡眠呼吸暂停患者的短期血压变异性。方法 将155例分为对照组、高血压组、高血压合并轻度或中重度阻塞性睡眠呼吸暂停组，EE较患者不同活动状态的短期血压变异性。结果 高血压合并中重度阻塞性睡眠呼吸暂停组患者睡眠期间和早晨血压变异系数分别为：收缩压18．69、21．32；舒张压19．41、23．61，明显高于其他各组。结论 夜间睡眠期间和早晨短期血压变异性增加，是高血压合并中重度阻塞性睡眠呼吸暂停患者夜间和早晨心血管事件发生率增加的重要危险因素。     

睡眠状态下人体生理信号模糊分析系统的研究

采用LabVIEW技术完成对心电、呼吸、无创血氧和无创血压信号的采集与处理,而后通过MATLAB模糊测量系统对采集的人体生理信号进行模糊预测分析。通过实验检验了人体生理信号检测、处理和模糊预测分析方法的可靠性。LabVIEW技术对人体生理信号的模糊预测分析是有效的,可用于检测阻塞性睡眠呼吸暂停患者的生理状态信号。